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The Specialist Performing Your Colonoscopy May Be As Important As The Test Itself

February 25, 2010

"March is National Colorectal Cancer Awareness Month, which provides the perfect reminder to patients aged 50 and older that they need to be screened for colorectal cancer," said Gail A. Hecht, MD, MS, AGAF, president of the American Gastroenterological Association (AGA) Institute. "Colorectal cancer is the third leading cause of cancer death, but it is one of the most preventable cancers when caught earlier. We cannot emphasize strongly enough that screening saves lives. Patients should talk to their doctors to discuss all of their colorectal cancer screening options." The incidence of CRC has declined in recent years in part due to more screening for the disease. However, many Americans haven't gotten the message about screening. There are a number of options for screening—stool blood test, sigmoidoscopy, colonoscopy, CT colonography (or "virtual colonoscopy")—and some confusion about which test is best. Everyone age 50 and older should talk with their doctor to determine which test is right for them. The AGA considers colonoscopy to be the gold standard for detecting and removing adenomas, and colonoscopic polypectomy (removal of any polyps during the procedure) is associated with a reduced incidence of colorectal cancer. Unlike a virtual colonoscopy that only images the colon, a colonoscopy enables the doctor to see and remove any suspicious polyps then and there. Because these lesions are extremely slow growing, if your colonoscopy didn’t detect any growths you typically don’t need to repeat the test for 10 years. (If any are found and removed, the retesting window is shorter.) Now, a new study of over 110,000 participants, ages 50 to 80 years old, has revealed that the training of the medical doctor performing the test has an outcome on whether patients end up developing colorectal cancer in the years afterwards. Despite having a negative complete colonoscopy, those who had their colonoscopies at a hospital and had their procedures performed by a non-gastroenterologist seem to be at a significantly increased risk of developing subsequent colorectal cancer (CRC), according to the new study, published in Clinical Gastroenterology and Hepatology, the official journal of the AGA Institute. "The overall incidence of colorectal cancer is reduced for at least 10 years following a negative colonoscopy, compared with the general population. However, colorectal cancers do occur in individuals following a negative colonoscopy," said Linda Rabeneck, MD, MPH, of the University of Toronto and lead author of this study. "For this reason, having extensive formal training matters, especially when procedures are more challenging to perform. We found that among those physicians who perform colonoscopy in the hospital setting, gastroenterologists are more proficient at colonoscopy than other physicians, including general surgeons. This may reflect the considerable formal training in endoscopy that forms part of gastroenterology core training requirements in the U.S. and Canada." The conclusions suggest that a trained gastroenterologist can better spot and remove polyps that, if not removed, will progress to cancer.

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